Long-term use of bisphosphonates (BPs) is associated with Atypical Femoral Fracture (AFF). Theoretically, periprosthetic femoral fractures (PFF) should be excluded from the diagnosis of AFF. However, recently several studies reported the occurrence of PPFs around a hip arthroplasty presenting features of an AFF. The present study describes the characteristics of Atypical Periprosthetic Femoral Fracture (APFF) and evaluates the effectiveness of their management through a PRISMA compliant systematic review of the published case reports and series.
A literature search was performed using "periprosthetic fracture" and "atypical femoral fracture" as keywords. Patients demographics, drug use, clinical and imaging characteristics, stem fixation and classification, management strategies for APFF and patients' outcomes, were also collected.
The present review included and analysed 17 patients from 12 studies. All APFFs occurred in females with a mean age of 75.9 years of age (range 43-87). In 11 patients, APFFs occurred around an uncemented stem, and in 6 around a cemented stem. Ten fractures were incomplete, and 7 complete. Conservative management was effective in 4 of 10 patients with incomplete fracture, while all patients with complete fractures underwent open reduction and internal fixation. A fracture non-union was observed in 5 patients and further surgery was required.
APFFs share several clinical and imaging characteristics with AFF. An appropriate and early diagnosis may allow to improve the outcome of these fractures, the management of which should be based on the same principles of that of AFFs.
Considering the low quality of published articles and the heterogeneity of the treatment used, a clear recommendation of the most appropriate treatment cannot be formulated.
Considering the low quality of published articles and the heterogeneity of the treatment used, a clear recommendation of the most appropriate treatment cannot be formulated.To evaluate the advantages of a carbon fiber-reinforced polyetheretherketone (CFR/PEEK) intramedullary nail on the diagnosis of fracture healing because of its radiolucency, we retrospectively reviewed radiographs and computed tomography (CT) images of trochanteric femoral fractures that underwent internal fixation with the CFR/PEEK intramedullary nail or a traditional metallic intramedullary nail.
Radiographs and CT images from 20 patients with intertrochanteric femoral fractures treated with a CFR/PEEK intramedullary nail and 20 similar patients treated with a metallic intramedullary nail were reviewed. After division of the intertrochanteric region into three zones on anteroposterior and lateral views of the radiographs, the visibilities of the fracture site, fracture line, and bone formation were evaluated in each zone. A three-grade assessment for existence of scattering and effect of scattering on diagnosis of the surrounding bone was performed on three axial slices of the CT images.
In the CFR/PEmpared with the metallic nail.
Superior fracture site visibility on radiographs was demonstrated in cases treated with the CFR/PEEK intramedullary nail compared with cases treated with the traditional metallic intramedullary nail, thereby confirming the advantages of the CFR/PEEK intramedullary nail for evaluation of fracture reduction and bone formation. The CFR/PEEK nail evoked little scattering on CT images, leading to higher diagnostic values for the peri-prosthetic cancellous and cortical bone compared with the metallic nail.Online diagnosis for sucker rod pumping well has great significances for rapidly grasping operations of the oil well. Feature extraction of the working condition and determination of the online diagnostic algorithm are two indispensable parts. In this paper, five feature vectors are extracted using Freeman chain codes. Then, an optimized density peak clustering (DPC) method is proposed to realize online diagnosis solved by an improved brain storm optimization (BSO) algorithm, in which the cloud model is adopted to generate new solutions in the searching space. During the online diagnosis process, a new cluster updating strategy is used to update the cluster centers online. According to the proposed online diagnostic method, various samples are automatically classified into different classifications by the unsupervised learning. The simulation results verify that the proposed online diagnosis method is satisfactory, which can give a higher and more stable diagnostic accuracy.The internal recirculation plays an important role on the different biological processes of wastewater treatment plants because it has a great influence on the concentration of pollutants, especially nutrients. Usually, the internal recirculation flow rate is kept fixed or manipulated by control techniques to maintain a fixed nitrate set-point in the last anoxic tank. This work proposes a new control strategy to manipulate the internal recirculation flow rate by applying a fuzzy controller. The proposed controller takes into account the effects of the internal recirculation flow rate on the inlet of the biological treatment and on the denitrification and nitrification processes with the aim of reducing violations of legally established limits of nitrogen and ammonia and also reducing operational costs. The proposed fuzzy controller is tested by simulation with the internationally known benchmark simulation model no. https://www.selleckchem.com/products/ikk-16.html 2. The objective is to apply the proposed fuzzy controller in any control strategy, only replacing the manipulation of the internal recirculation flow rate, to improve the plant operation.Therefore, it has been implemented in five operation strategies from the literature, replacing their original internal recirculation flow rate control, and simulation results are compared with those of the original strategies. Results show improvements with the application of the proposed fuzzy controller of between 2.25 and 57.94% in reduction of total nitrogen limit violations, between 55.22 and 79.69% in reduction of ammonia limit violations and between 0.84 and 38.06% in cost reduction of pumping energy.